Strategies People Use to Participate in Everyday Occupations When Experiencing Persistent Symptoms Following a Mild Traumatic Brain Injury: A Qualitative Descriptive Study

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Abstract

This exploratory study investigated the strategies that eight New Zealanders with persisting symptoms following a mild traumatic brain injury (mTBI) use to enable participation in day-to-day occupations that they need or want to do, in their homes, at work and in the community. The types of strategies that this group of people successfully use to mitigate against persisting symptoms is largely unreported in the literature.

This study utilised a qualitative descriptive methodology to investigate the question: “What strategies do people with persistent symptoms post mTBI use to manage everyday occupations?” This study had three purposes. First, to fill a gap in the literature and document specific strategies that people who do not make a full recovery from a mTBI use to manage their participation in everyday occupations. Second, to examine any patterns in the strategies adopted, which might indicate that the strategies used by this small sample of participants may benefit other clients to participate more fully in their everyday routines. Third, to determine if an occupational perspective could offer new insights and fruitful suggestions for further research.

Semi-structured interviews were held with eight people who volunteered to participate in this study after being approached by a third party. A conventional thematic analysis resulted in a nuanced account of developing strategies in direct response to unresolved mTBI symptomology and experiences, as the participants endeavoured to resume participation in previously familiar domestic, community and work related occupations.

In presenting the findings, the strategies were initially divided into two categories reflecting if they were deployed in the early stages of recovery (1-12 weeks post injury), or later in the recovery process. For the strategies deployed in the early stages of recovery, three themes emerged. These were taking off the load, relearning how to do things, and making things easier. In the later stages of recovery, further strategies were developed to manage the trifecta of symptoms that persisted post mTBI, categorised as matching occupational demands with available energy, achieving emotional control and managing the persistent changes in cognitive capacities, which were further broken down in to subthemes.

The findings demonstrated a reoccurring pattern in the recovery process which may be useful for developing into intervention programmes to meet the needs of people who do not experience a timely recovery from a mTBI. In particular, there was a relationship between capacity changes, fatigue, and the triggering of a stress response when routine occupations were unable to be executed, in same way prior to the injury. Three phases to the recovery process were identified. Phase one was characterised by taking off the cognitive load and reconfiguring simplified routines to meet essential self-care and productivity demands. The second phase required “recalibrating” the motor and cognitive components of problematic occupations, together with deploying compensation strategies, so occupational routines could be reliably performed. The final phase of the successful development of occupational functioning was accepting the changes in the way occupations were performed and stopping the struggle to get better.

The insights demonstrated in this research reinforce the complexity of learning how to manage simultaneously alterations in energy levels, emotional regulation and processing capacities. The occupational perspective shows how occupations which were routinely performed prior to the mTBI can be reconfigured and a satisfying balance between productively, leisure and play attained.